Women in the world’s least developed countries are 300 times more likely to die in childbirth or from pregnancy-related complications than women in developed countries, according to UNICEF’s latest State of the World’s Children report.

At the same time, a child born in a developing country is almost 14 times more likely to die during the first month of life than a child born in a developed one. The health and survival of mothers and their newborns are linked, and many of the interventions that save new mothers’ lives also benefit their infants. The 2009 edition of UNICEF’s flagship publication, The State of the World’s Children, highlights the link between maternal and neonatal survival, and suggests opportunities to close the gap between rich and poor countries.

"Every year, more than half a million women die as a result of pregnancy or childbirth complications, including about 70,000 girls and young women aged 15 to 19," said UNICEF’ international executive director, Ann M Veneman, at the Johannesburg launch. "Since 1990, complications related to pregnancy and childbirth have killed an estimated 10 million women." Both mothers and infants are vulnerable in the days and weeks after birth – a critical time for life-saving interventions, such as post-natal visits, proper hygiene, and counseling about the danger signs of maternal and newborn health.

While many developing countries have made excellent progress improving their child survival rate in recent years, there has been less headway in reducing maternal mortality. Niger and Malawi, for example, nearly cut their under-five death rates in half between 1990 and 2007, and in Angola the child mortality rate fell from 258 to 158 per 1,000 live births in the same time period. In Indonesia, under-five death rates fell to nearly a third of what they were in 1990, and in Bangladesh they fell by more than a half.

The same progress has not been made in addressing health risks for mothers, who are most vulnerable during delivery and in the first days after birth. And while the rate of survival for children under five years of age is improving globally, the risks faced by infants in the first 28 days remain at unacceptably high levels in many countries.

In the developing world, a woman has a 1 in 76 lifetime risk of maternal death, compared with a probability of 1 in 8,000 for women in developed countries. Approximately 99 per cent of global deaths arising from pregnancy and complications occur in the developing world, where having a child remains among the most serious health risks for women. The vast majority occur in Africa and Asia, where high fertility rates, a shortage of trained personnel and weak health systems spell tragedy for many young women.

The 10 countries with the highest lifetime risk of maternal death are Niger, Afghanistan, Sierra Leone, Chad, Angola, Liberia, Somalia, the Democratic Republic of Congo, Guinea-Bissau, and Mali. A woman’s lifetime risk of maternal death in these countries ranges from 1 in 7 in Niger to 1 in 15 in Mali.

And for every woman who dies, another 20 suffer illnesses or injuries, often with severe and lasting consequences. To lower maternal and infant mortality, the report recommends essential services be provided through health systems that integrate a continuum of home, community outreach and facility-based care. This continuum of care concept transcends the traditional emphasis on single, disease-specific interventions, calling instead for a model of primary health care that embraces every stage of maternal, newborn and child health.

"Saving the lives of mothers and their newborns requires more than just medical intervention. Educating girls is pivotal to improving maternal and neonatal health and also benefits families and societies." The report finds that health services are most effective in an environment supportive of women’s empowerment, protection, and education.